unit 7 - nutley public schools and...stages and needs of the individual to provide quality health...
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7:1 Life Stages
§ Growth & development is a lifelong process – Begins at birth and ends at death
§ During an entire lifetime, individuals have needs that must be met
§ Health care workers need to be aware of the various stages and needs of the individual to provide quality health care
§ Life Stages – defined stages of growth and development throughout a person’s life
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Life Stages
§ Infancy: birth to 1 year § Early childhood: 1-6 years § Late childhood: 6-12 years § Adolescence: 12-20 years § Early adulthood: 20-40 years § Middle adulthood: 40-65 years § Late adulthood: 65 years and up
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Growth and Development Types § As an individual passes through the life stages, four main
types of growth and development occur – Physical: body growth
• Height, weight, muscle and nerve development – Mental: mind development
• Problem solving, values, ethics, how to make judgments – Emotional: feelings – Social: interactions and relationships with others
§ In each life stage, all 4 types of growth must occur and the individual must develop certain tasks – Tasks progress from simple to complex as the individual
ages (Example: sitting up à stand à walk à run)
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Erikson’s Stages of Psychosocial Development
§ Erik Erikson was a psychoanalyst who identified eight stages of psychosocial development
§ In each stage of development, an individual is met with certain conflicts and major life events – A basic conflict or need must be met in each stage – Erikson believes if the conflict is not resolved, the
individual will struggle with the same conflict later in life § See Table 7-1 in text (pg 170)
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Infancy § Age: birth to 1 year old, most dramatic changes in growth § Physical development
– Weight: Newborn (6 – 8 lbs), 12 months (21 – 24 lbs) – Muscular and motor skills develop, teeth grow in
§ Mental development – By 12 months, infants understand language and may use simple words
§ Emotional development – Emotions and feelings develop: excitement, affection, anger, fear
§ Social development – Recognize caregivers, may be shy with strangers
§ Infants are dependent on others for all needs
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Early Childhood § Age: 1-6 years old § Physical development
– Weight: about 45 lbs by age 6 – Legs and lower body grow faster than head, arms, chest – Can eat adult foods; by 2-4 yrs should gain bladder and bowel control
§ Mental development – Vocabulary and communication skills develop – Memories develop and are used to make decisions
§ Emotional development – Learn how to deal with new experiences, learn right/wrong, like routines
§ Social development – Become attached to caregivers, enjoy playing with others but can be
very possessive § Needs include food, rest, shelter, protection, security. Need
routine, order and consistency. Must be taught responsibility.
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Late Childhood (Preadolescence) § Age: 6-12 years old § Physical development
– Weight: Typically increases 5 – 7 lbs a year – Height: Typically increases 2 – 3 inches a year – Develop complex motor-sensory coordination – Baby teeth lost, permanent teeth grow in – May start puberty towards end of late childhood (10 – 12 yrs)
§ Mental development – Increases rapidly due to schooling – Develop abstract concepts (loyalty, honesty, values, morals)
§ Emotional development – Able to deal with emotions in a more effective manner
§ Social development – Major changes during this stage
§ Needs include basic needs in addition to approval and acceptance
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Adolescence § Age: 12-20 years old § Physical development
– Most dramatic changes occur in early period • “Growth spurt” can cause rapid changes in height/weight
– Puberty – secretion of sex hormones, development of secondary sexual characteristics
§ Mental development – Increase knowledge and sharpen skills, develop decision making
process, values, morals
§ Emotional development – Difficult during early period, towards end self-identity has been
established and teens may feel more comfortable with themselves
§ Social development – Spend less time with family and more with peer groups
§ Needs include basic needs in addition to reassurance, support and understanding.
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Adolescence § Many problems that develop in this stage can be
attributed to feelings of inadequacy or insecurity § These life-long problems include:
– Eating disorders • Anorexia, Bulimia • Often develop due to an excessive concern with appearance • More common in females • Treatments include therapy, nutrient supplements, hospitalization
– Drug and alcohol abuse • Development of dependence on drugs/alcohol, can lead to physical
and mental disorders • Abuse often starts due to peer pressure; desire to escape anxieties,
emotional or psychological problems; hereditary traits • Treatments include therapy, hospitalization, rehab
– Suicide
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Suicide § One of the leading causes of death in adolescents § Permanent solution to temporary problem § Reasons for suicide include depression, abuse, grief, feelings
of failure, influence from friends or family, lack of self-esteem § Risks increased by family history, major loss or disappointment,
recent suicide of friend/family § Most give warning signs such as sudden changes in behavior,
withdraw, depression, moodiness, chemical abuse, loss of interest in life, self-injury, saying goodbye to family/friends
§ Techniques to prevent suicide include counseling, support, therapy, hospitalization, rehab
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Early Adulthood § Age: 20-40 years old § Physical development
– No major changes, prime childbearing age § Mental development
– Continues with education, independence, increasing personal responsibility
§ Emotional development – Many emotional stresses from career, marriage, family, friends
§ Social development – Involves moving away from peer groups and becoming
involved with a mate § Needs same as adolescent
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Middle Adulthood (Middle Age)
§ Age: 40-65 years of age § Physical development
– Gray/thinning hair, wrinkles, decreased muscle tone and vision, hearing loss, weight gain, menopause (females)
§ Mental development – Continues to increase
§ Emotional development – Varies based on personal experiences and events
§ Social development – Varies based on personal experiences and events
§ Needs remain the same
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Late Adulthood (Elderly, Senior citizen, Golden ager, and Retired citizen)
§ Age: 65 years of age and up § Physical development
– Declining, age spots on skin, thinning/loss of hair, thinning cartilage, decline in nerve functioning, memory loss, decrease lung capacity
§ Mental development – Varies, some may develop Alzheimer’s disease
§ Emotional development – Varies based on how person adjusts to changes occurring in their life
§ Social development – Retirement may lead to loss of self-identity/esteem – May have loss of relationships due to retirement/deaths
§ Needs now also include sense of belonging, self-esteem, financial security, social acceptance, love
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7:2 Death and Dying
§ Death is “the final stage of growth” § Experienced by everyone § Young people tend to ignore its existence § Usually it is the elderly, who have lost others, who
begin to think about their own death § Terminal illness – disease that is not curable, will
result in death – Patients react differently to this diagnosis
• Common reactions: fear, anxiety, acceptance
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Dr. Elizabeth Kübler-Ross
§ Dr. Elizabeth Kübler-Ross – researched the process of death and dying
§ Results of her research – Most medical personnel now believe patient
should be informed of approaching death – Patient should be left with some hope and know
they will not be left alone – Staff need to know what information is known by
patient and how the patient reacted
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Dr. Elizabeth Kübler-Ross
§ 5 stages of grieving were identified § Dying patients and their families/friends may
experience these stages § Stages may not occur in order, may overlap or be
repeated § Some patients may not progress through them
all, others may experience several stages at once
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Stages of Death and Dying
§ Denial – refuses to believe § Anger – when no longer able to deny § Bargaining – accepts death, but wants more time § Depression – realizes death will come soon § Acceptance – understands and accepts the fact
they are going to die
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Caring for the Dying Patient
§ Very challenging, but rewarding work § Supportive care § Health care worker must have self-awareness
– Need to come to terms with own personal feelings about death
§ Common to want to avoid feelings by avoiding dying patient
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Hospice Care
§ Palliative care for patients with less than 6 months to live – Palliative care – provide support and comfort
• Pain management, counseling, holistic care
§ Offered in hospitals, medical centers, but most often in patient’s home
§ Philosophy: allow patient to die with dignity and comfort
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Right to Die
§ Health care workers must understand this issue – Some people feel that an individual with a terminal illness
should be allowed to refuse measures to prolong their life § Ethical issues must be addressed § Allowing patients to die can cause conflict § Specific actions to end life cannot be taken § Laws allowing “right to die”
– Allow adults to instruct doctors to withhold treatments • Type of advanced directive
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Summary
§ Death is a part of life § Health care workers will deal with death
and dying patients § Must understand death and dying process
and think about needs of dying patients § Then health care workers will be able
to provide the special care these individuals need
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7:3 Human Needs § Needs: lack of something that is required or desired § Needs exist from birth to death § Needs influence our behavior § Needs have a priority status § When needs felt, individual is motivated to meet
these needs – Sense of satisfaction when needs met – Sense of frustration when needs not met
§ Several needs can be felt at the same time § Different needs can have different levels of intensity
§ Maslow’s hierarchy of needs – Developed by Abraham Maslow, psychologist – 5 levels of needs – See Figure 7-13 in text (pg 180)
§ Lower needs must be met before the individual can try to meet the higher needs
Maslow's Hierarchy of Needs
§ Physiological needs – aka physical, basic – Food, water, oxygen, homeostasis, sleep, etc – Most are automatically controlled by body – Health care workers need to be aware of how
an illness interferes with the physiological needs
Maslow's Hierarchy of Needs
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Altered Physiological Needs § Health care workers need to be aware of how
illness interferes with meeting physiological needs – Must understand how treatments interact with body
§ Surgery or laboratory testing – May not be able to eat or drink before/after test
§ Anxiety – May cause changes in person’s behavior – May interfere with sleep or bathroom habits
§ Medications – May affect appetite, sleep, bathroom habits
§ Loss of vision or hearing – May cause difficulties in communication
§ Safety – Free from anxiety, fear; feel secure – Need routines, allow to become familiar – Health care workers need to provide support
and allow patients to adapt and feel comfortable
§ Affection – Sense of belonging, friendship and love – Also involves gender identity, sexuality
Maslow's Hierarchy of Needs
§ Esteem – Self-respect, approval from others – Illness may have a major effect on esteem
• Health care workers need to provide supportive care, and allow the person to express their anger/fear
§ Self-realization – Obtain full potential; feel confident and secure with
self
Maslow's Hierarchy of Needs
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Methods for Satisfying Needs
§ Direct methods – Hard work – Set realistic goals – Evaluate situation – Cooperate with others
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Methods for Satisfying Needs
§ Indirect methods - Defense mechanisms – Def: Unconscious act that helps a person deal with an
unpleasant situation – Rationalization – use reasonable excuse for behavior in
order to avoid the real reason behind an action – Projection – placing blame for own action on someone else – Displacement – transferring feelings about one person to
someone else – Compensation – substitution of one goal for another goal in
order to feel or achieve success – Daydreaming – provides a means of escape if a person is
not satisfied with reality
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Methods for Satisfying Needs Indirect methods (continued)
– Repression – transfer of unacceptable of painful ideas to unconscious mind
– Suppression – similar to repression, but the individual is aware of the unacceptable feelings and refuses to deal with them
– Denial – not able to accept a frightening or shocking event as a reality
– Withdrawal – two types • Withdraw by ceasing to communicate • Withdraw by removing self from situation
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Summary
§ Be aware of own needs and patient’s needs § More efficient and quality care can be provided
when know needs and understand motivations § Better understanding of our behavior and that
of others
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7:4 Effective Communications § Health care workers must be able to relate to
patients, family, coworkers, and others § Communication - exchange of information,
thoughts, ideas, and feelings – Written – communication through written correspondence – Verbal – communication through spoken words – Nonverbal – communication through body language,
facial expressions, touching • Can conflict with verbal message • Need to be aware of own and other’s nonverbal messages • When verbal and nonverbal message agree, message is more
likely to be understood
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Communication Process
§ Essential elements – Sender – individual who cerates a message to convey info/
idea to another person – Message – info, ideas or thoughts being communicated – Receiver – individual who receives the message from the
sender – Feedback – method used to determine if communication
was successful • Receiver responds back to the sender regarding the message • Allows original sender to determine if the message was interpreted
correctly
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Communication Process In order for communication to be effective, the: § Message must be clear
– Message in terms understood by sender and receiver – Health care workers must be able to effectively communicate
diagnoses, symptoms, and treatment § Message must be delivered in a clear manner
– Sender must use proper grammar and pronunciation – Sender must use proper tone, pitch, voice level and speed
§ Receiver must be able to hear and receive the message – Sender must make sure the receiver is coherent, and
understand the language being used – Repeating the message, changing the terms used or
language used may help to clarify the message
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Communication Process In order for communication to be effective, the: § Receiver must be able to understand message
– Usage of medical terminology may cause miscommunication – Health care workers should ask questions or repeat info
differently if it appears the patient doesn’t understand – Receivers must be confident in the sender before they
accept and understand the message § Environment should be clear of interruptions and
distractions – Limit distractions such as phone calls, television, iPads
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Listening § Listening is essential to effective communication § Attempt to hear what other is really saying § Need constant practice § Good listening techniques include:
– Showing interest and concern for what speaker is saying – Be alert and maintain eye contact (if appropriate) – Avoid interrupting speaker – Avoid thinking about how you are going to respond – Try to see the speaker’s point of view & keep your temper
under control – Reflect statements back to speaker – Ask for clarification if you don’t understand part of message
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Barriers to Communication § Barrier - something that gets in the way of clear communications § 3 Common barriers (Physical, Psychological, Cultural) § Physical disabilities
– Deafness or hearing loss • Try using body language, face the patient when speaking,
write message – Blindness or impaired vision
• Use a soft tone of voice, describe events, explain sounds, announce when you come into room
– Speech impairment • Encourage patient to take their time during communicating,
ask questions that don’t require long answers, repeat message back to patient, provide a picture board or other means of communication
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Barriers to Communication Common barriers § Psychological barrier
– Caused by prejudice, attitudes, and personality – Judgments typically based on appearances,
stereotypes, social and economic status – Health care workers must put all prejudices aside
and show respect to all patients • Must be respectful even if the patient has a negative
attitude
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Barriers to Communication Common barriers § Cultural diversity
– Main barriers include: • Beliefs and practices regarding health and illness • Language differences • Eye contact • Ways of dealing with terminal illnesses • Touch
– Respect and acceptance of cultural diversity is essential for health care workers
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Recording and Reporting
§ Observe and record observations § Use all senses in the process
– Sight – skin color, swelling, rash, urine color – Smell – unusual body odor, breath, smell of
wound, urine or stool – Touch – feel for pulse, dryness or temp of
skin, swelling – Hearing – listen to heart beat, breathing,
coughs, speech
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Recording and Reporting
§ Observations must be reported promptly and accurately – Subjective observations – complaints made
by patient, report in exact words patient uses • Cannot be seen or felt by health care worker
– Objective observations – seen and measured • Blood pressure, temp, swelling, cut, rash
§ Criteria for recording observations on a patient’s health care record
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Recording and Reporting
§ Observations are recorded on a patient’s health care record – Need to be written accurately, concise & complete
• Sign and date all entries • Errors should be crossed out in a neat, straight line and initialed
– Writing should be neat and legible with correct spelling and grammar
– Record objective observations • If subjective observations are put in record, must be written in
exact terms patient used
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Summary
§ Good communication skills allow development of good interpersonal relationships
§ Health care worker also relates more effectively with coworkers and other individuals
Communication Skills – Count the “F”s in the following statement:
§ Fascinating fairytales are the result of years of scientific study combined with the experience of creative minds.
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Communication Skills – Count the “F”s in the following statement:
§ Fascinating fairytales are the result of years of scientific study combined with the experience of creative minds.
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Drawing a Bug
§ I am going to describe a drawing of a bug. Without seeing the drawing, you must draw the bug as I describe it to you.
§ You may NOT ask questions! § You may NOT talk to each other!
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Drawing a Bug Discussion questions: § Why don't all the bugs look like mine? § What did you think of first when you were told to draw a bug?
What did you see in your mind? § What could we have done differently so that your drawings
and mine would have looked more alike? Could nonverbal communications have helped?
§ What would have been the advantages of allowing questions to be asked?
§ How many of you wanted questions to be asked?
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